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Sample Copy - Mphasis &finsource PDF

This 3 sentence summary provides the key details from the employee provident fund settlement application document: The document is an application from an employee who is separating from their role at Mphasis Limited, with their last date of employment and reason for leaving. It requests settlement of the employee's provident fund account and declares that they have not been reemployed for at least 2 months. The employee authorizes the deduction of any applicable income taxes from the provident fund payout.

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Sameer Shaikh
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Download as PDF, TXT or read online on Scribd
279 views

Sample Copy - Mphasis &finsource PDF

This 3 sentence summary provides the key details from the employee provident fund settlement application document: The document is an application from an employee who is separating from their role at Mphasis Limited, with their last date of employment and reason for leaving. It requests settlement of the employee's provident fund account and declares that they have not been reemployed for at least 2 months. The employee authorizes the deduction of any applicable income taxes from the provident fund payout.

Uploaded by

Sameer Shaikh
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Employee Code:

Mention your employee ID

APPLICATION FORM TOWARDS PROVIDENT FUND SETTLEMENT

To, Date : _________________


The Trustees
Mphasis Group Employees Provident Fund
Bagmane World Technology Centre 3,Block B, 1st floor, Mention employee name as
Marthahalli Outer Ring Road, Doddenekundi, Mahadevpura,
per the company records
Bangalore - 560 048.

1. *I Mr /Mrs/ Ms.(Name in block letter) ______________________________________________________ ceased to


be an employee of M/S Mphasis Limited with effect from (Date of Leaving)___________________________________
on account of:-
(tick the below appropriate box)
Mention the Date of Separation
Mention the reason for leaving.
Reason for leaving

Retirement Medical unfitness  Death  End of Contract  Permanent settlement abroad

Resignation  Retrenchment  VRS  Termination  others (specify) ____________________________

Mention father/husband name


*2 ) Parent Name (Husband name in case of married women) : ______________________

*3 ) Address for Communication : _____________________________________________________________________


Mention your postal address with PIN#

__________________________________________________________
Mention your phone # & Email ID City: ___________________________________

*Pin Code: __________________*Phone : ______________________ *Email : ________________________________

* Gender *PF No. KN/16573/ *PAN

*Employee Code EPS No. KN/16573/

*Date of Birth *Date of Joining

*Bank A/c no. *Bank Name


*Branch IFSC
*Branch Name
Code

Employee needs to sign here Fill above Information as they are mandatory *

* Signature of Employee Signature of Employer/Authorized official

1
DECLARATION

Mention your PF #
1) Declaration of Non-Employment

You are requested to settle my Provident Fund Account KN/16573/_____________

I hereby declare that I have not been employed in any factory/establishment to which the Employees’ Provident Funds
and Miscellaneous Provisions Act,1952 applies for a continuous period of not less than two months immediately
preceding the date of my application for final withdrawal of my Provident Fund money.

Employee needs to sign here

* Signature of Employee

2) Authorizing for Deduction of Income Tax

The Board of Trustees of Mphasis Group Employees’ Provident Fund or any person authorized by it shall deduct Income
Tax as per the provisions of Income Tax from the payment of accumulated balance due to be paid which is not
exempted from Tax and liable to be included in the total income as provided under the Rule 8 or 10 of Part A of the 4 th
Schedule of the Income Tax Act, 1961.

I hereby agree with the terms and conditions described above.

Employee needs to sign here

* Signature of Employee

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